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Posted on February 4, 2013 |

What seemed striking about the “death with dignity” debate that filled the State Capitol this past week were the juxtaposed tones from each respective side: compassion to ease the suffering of loved ones was the predominant message of those who supported the legislation; a more strident argument against the moral affront the bill poses dominated the testimony of those opposed.

Vermonters rightfully perplexed by complex feelings about this issue might reflect on those countering arguments to draw their own conclusions.

Those who view the legislation as an act of compassion most often relay actual circumstances when a patient is in the last stages of death. Immense pain is often a factor, requiring heavy doses of morphine or other drugs that keep the patient in a drug-induced state for much of those final weeks. With fast-spreading cancers or other terminal illnesses for which doctors see no cure, the patients and their families argue that they should have a choice in determining how to live those final days in a way they deem dignified.

It is not a request that denies any rights to others. The proposed legislation offers a choice for a dignified death; it does not mandate any prescribed process for others.

Opponents of the measure, on the other hand, are acting to deny individuals who are facing imminent death the right to choose how to live out those final days. Like many groups who oppose extending individual rights to others, their position is that such laws would create a slippery slope of good intentions gone awry, opening up the possibility for abuse and — at the height of their paranoia — for the state government to assume control of such decisions and dictate that choice for all. It is an argument based on unfounded fears.

There have, however, been valid questions asked and addressed. How can we be sure that a prognosis is terminal? How can the law insure family members are not putting pressure on a patient to choose death over life for financial reasons? How can we be sure that the patient is of sound mind when that decision is made?

During the past decade, the legislation has added multiple layers to prevent abuse. A safety net exists, says Vermont Attorney General Bill Sorrell, to prevent the abuse of end-of-life measures, including the following measures: patients would have to be diagnosed by two physicians as being terminally ill with a prognosis of death within six months; patients with depression or other mental disorders would not be eligible; all patients opting for assistance from a doctor to help end their lives would have to be enrolled in palliative care or undergo a palliative care consultation.

There is also a mandated time for reflection. After a patient requests to end his life or her life, the physician would have to wait at least 15 days and then get a reaffirmation of the patient’s wish to die; and then offer the patient a chance to rescind the request. To avoid family pressures, the request by the patient has to be signed by two witnesses who are not relatives of the patient or another acting physician.

Nor does the proposed legislation require doctors to participate. Any doctor may choose to opt out of having to make the diagnoses.

In his testimony in front of the Senate Health Care and Judiciary Committees this past week, Sorrell said the legislation has been tweaked over the years to protect providers, the patient and the families and sets a solid foundation for patients to make informed choices.

“I think the right to make an informed decision about the end of your life when you are terminally ill and you have all of your faculties about you, the option to be able to make that choice,” Sorrell said, “is a simple one — I think it’s a personal right.”

That doesn’t mean that others who hold differing views are wrong in their beliefs. But it does pose this fundamental question to senators who are expected to face a vote within the next three weeks: What is gained by denying this choice to those who are facing imminent death? With their vote, who has been helped and have those on the other side been harmed?

And while doctors throughout the state also have differing views, Dr. Diana Barnard, a palliative physician based in Middlebury, said in her testimony to the committees: “I want to do everything I can to alleviate people’s suffering and I think this bill can do that.”

Where is the harm in that? Where is the value in denying that choice to others? That’s what the Vermont Legislature must answer.